Candida Infections in Solid Organ Transplantation

Abstract

Candida remains a common infectious complication in the setting of solid organ transplantation. The rates of invasive Candida infection vary among organ transplant, with small bowel accounting for the majority of cases. In this chapter, we review the epidemiology of Candida infections following organ transplantation. While C. albicans continues to be the most common fungal species isolated, more recent data show that non-albicans Candida species are on the rise, specifically drug-resistant C. glabrata. These non-albicans Candida species are associated with an increase in mortality compared to C. albicans. In addition, we examine the available tools for the diagnosis of invasive Candida infections, including traditional culture techniques, fungal cell wall markers, antibody serologies, and more efficient approaches using nucleic acid-based detection. A special section discusses the emergence of the highly drug-resistant fungal pandemic agent, C. auris. That said, improved surgical technique, patient-specific chemoprophylaxis, and early use of anti-fungal agents have resulted in decreased mortality due to Candida infection. Therapeutic drug monitoring of specific agents is reviewed. Finally, future consideration for more rapid diagnostics and a personalized approach to risk stratification and identification of those individuals who would benefit the most from pre-emptive strategies following transplantation are discussed.

Invasive fungal infections in liver diseases

“…However, recent data show a change in Candida species over time, with a rise in nonalbicans species, including C. parapsilosis, responsible for 19%–28% of all invasive candidiasis. 21 …”